Active NPI
SS Pharmacy Holdings Inc
- Community/Retail Pharmacy
- Longview, TX
National Provider Identifier
1609828854
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 23908
- Legal business name
- SS PHARMACY HOLDINGS INC
- Practice address
- 3212 N 4TH St
Longview, TX 75605-5143 - Phone
- (903) 236-9676
- Fax
- (903) 236-9376
- NPI assigned
- May 16, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Gary Chad Collins
- Title
- Ceo
- Phone
- (214) 624-3050
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 23908 | TX | Primary |
Addresses
Primary practice location
3212 N 4TH St
Longview, TX 75605-5143
Mailing address
PO Box 803493
Dallas, TX 75380-3493
Phone (214) 624-3073
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2097544 | Other | PK | |
| 145569 | Medicaid | TX |
Other names 1
- QVL PHARMACY # 101
National Provider Directory
National Provider Directory- Tax ID family
- Advanced Pharmacy Solutions
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Psychiatric Pharmacist
- Southaven, MS
- NPI 1801002001
Locations
3212 4th St
Longview, TX 75605
Phone (903) 236-9676
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147737600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1402963200000",
"number": "1609828854",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 803493",
"city": "DALLAS",
"state": "TX",
"postal_code": "753803493",
"telephone_number": "214-624-3073",
"fax_number": "214-989-7986"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3212 N 4TH ST",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756055143",
"telephone_number": "903-236-9676",
"fax_number": "903-236-9376"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SS PHARMACY HOLDINGS INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-16",
"last_updated": "2014-06-17",
"status": "A",
"authorized_official_last_name": "COLLINS",
"authorized_official_first_name": "GARY CHAD",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "214-624-3050"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "TX",
"license": "23908",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2097544",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "145569",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "QVL PHARMACY # 101",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Longview, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.